Phillipian Commentary: Our Solution to the Modern Healthcare Crisis

When I was eight years old, I spilled scorching hot coffee on myself while unsuccessfully attempting to reach for a mug on a high kitchen cabinet. As the coffee mug fell from my hands and down from the cabinet, the steaming liquid poured out, instantly piercing through my delicate baby skin and causing a stinging pain I will never be able to forget. My mom tells me that she was so frightened that night that her hands trembled on the steering wheel as she drove me to the hospital. For the next two weeks, I was stuck in the burn center, where my life was a daily repetition of morning treatments and evening dressings. Living with a huge bandage covering the left side of my face and arm was quite burdensome, as it took me so much effort just to eat. Thanks to the careful treatment of my doctor and other hospital staff, I left the burn center two weeks later with the burn on my face completely gone. However, the deeper wound on my right arm still remains as a scar, an oval patch of skin slightly darker than the other parts, reminding me of the two weeks of intense pain I endured from my burn. I often wondered to myself whether a drug could have expedited my healing process and saved me from the weeks of pain I remember so vividly.

I recently stumbled across a revolutionary new type of burn therapy online, called ExpressGraft. ExpressGraft is a type of gene therapy that consists of inserting a gene with the correct version of DNA into the cells of the patient. ExpressGraft didn’t exist back when I burned myself seven years ago, but even if it had, it’s unlikely that I could have afforded to receive gene therapy to treat my burn, as these types of treatments can cost hundreds of thousands of dollars. According to a recent survey by the “Insurance Journal”, most insurance companies do not cover this class of therapy or only allow it after all other options have been exhausted, preventing numerous burn patients from receiving this life-changing treatment. I believe patients should receive the best care available, even if the drug has a significant price-tag, because coverage of next-generation drugs promotes further drug innovation and prevents costly long-term complications.

The reason why the road to new methods of treatment and technologies is far and rough for many patients suffering from rare illnesses[a][b] is due to our current healthcare system. Some in the U.S.A. blame high drug prices for unaffordable health care, but in reality, drug prices constitute a minor portion of healthcare spending. According to the Commonwealth Fund, the healthcare system of the United States ranks last out of the eleven wealthiest nations around the world, even though the U.S.A., spent 3.5 billion dollars in healthcare in 2017. However, spending on pharmaceutical drugs only constitutes 10 percent of all healthcare spending. It is lack of significant drug coverage by insurance companies that results in low patient access to necessary drugs. As this shows, criticism toward high drug prices by the public may not be very accurate as most healthcare costs come from physician services and hospital care and lack of coverage is due to insurance companies making profits off patients. For that reason, nearly one in two sick Americans, even those who are health insurance holders, are unable to afford healthcare, according to a new analysis by the Kaiser Family Foundation. This is a huge problem—the overwhelming costs of the drugs should never be an obstacle for patients receiving treatment.

The public needs to focus more on core issues such as reducing costs for physician services and hospital care as well as limiting the profitability of insurance companies. It is very inefficient if new, effective technology and treatment is not widely used by patients, and it would just be the pharmaceutical companies wasting money and effort on developing meaningless drugs if only a small amount of people are able to afford the costs. While ExpressGraft can actually save patients money in the future, our ineffective healthcare system is unable to make that happen.

There is a reason why these drugs are covered by insurances. Pharmaceutical companies require adequate profits in order to continue manufacturing and researching new drugs. It is the wide belief of the public that it is very expensive to develop a drug, which is partially true and is what the pharmaceutical industries want people to know. [c][d]This means that negotiations conducted by insurance companies to lower the cost of the drugs would be futile, as the pharmaceutical companies themselves need to earn money to continue their business of developing new drugs and cures for rare illnesses. Also, because the number of patients using these different insurance companies is so scattered, negotiations to lower the price of the drugs is getting harder for the insurance companies to achieve.

For instance, Zolgensma, a drug used to treat spinal muscular atrophy, a genetic disorder characterized by the steady depletion of muscles used for movement, according to the U.S.A. Library of Medicine, is extremely high-priced compared to other drugs used to treat the same illness like Spinraza. However, the difference is that Zolgensma is a one-time treatment, that ultimately reduces healthcare expenses. Zolgensma would cost less than other drugs that require to be regularly paid for and used over the course of many years, but patients eliminate Zolgensma as a viable treatment option when they see the 2.125 million dollars price tag, especially since it is covered by less than half of insurance companies due to its expensive cost. This makes it virtually inaccessible to patients.

Similarly, ExpressGraft, the gene therapy treatment for burn patients, is most likely not to be covered by most health insurances due to the cost. ExpressGraft is not yet F.D.A. approved, and there is a very low possibility it will be[e][f] in the future. ExpressGraft may not be covered on health insurance for burn patients because it is so expensive, but gene therapy, in the long run, works a lot better for these patients, as it reduces instances of infection, inflammation, reclosure, etc. This actually helps patients save money, because in the future they do not have to pay for multiple other treatments caused by infections.

The best solution for this problem is public healthcare coverage for all U.S.A. citizens and the advocacy of using drugs that, in the long run, can be economical. Healthcare is cheaper when offered through the government because there is increased negotiating power with more patients covered. With more coverage, an increased number of patients receive the drug more consistently, which results in the manufacturers actually making more money. Also, more people should be aware and eager to solve healthcare issues, so that there can be more discourse between the pharmaceutical companies and public insurance companies to lower the costs of the drugs and make it more accessible to the public. With the prices of gene therapy negotiated due to public health insurance, I may have been able to use ExpressGraft as a way of my treatment, and the scar on my right arm would have disappeared![g][h]